Economic evaluation of an implementation intervention to increase outdoor free play in early childhood education

Get Outside Get Active (GOGA) is a multi-component implementation strategy (six strategies) to increase the provision of outdoor free play opportunities in early childhood education and care (ECEC). A randomized controlled trial with 84 ECECs within New South Wales, Australia found an increase of 61 min of outdoor free play opportunities per day, per service in the intervention compared with usual care at 6-months follow-up (P = .041). This study estimated the absolute costs associated with delivery of GOGA, and cost-effectiveness in terms of cost per additional minute of outdoor free play opportunities per day, per service. Costs ($AUD) were evaluated from health and ECEC service perspectives. Total and average costs per service to deliver GOGA and costs per strategy, per ECEC were calculated. Incremental cost-effectiveness ratios (ICERs) were estimated for differences in costs and effects between intervention and usual care. The total cost of GOGA (42 intervention services) was $69 351 (average $1651 per service). Educational outreach visits were most expensive at $32 498 (average $774 per service, average one visit per service), with develop and distribute educational materials least expensive at $1490 (average $35 per service). The difference in mean cost between usual care and intervention (adjusted for baseline) was $3740 (95% CI $418, $11 218) per service, with an adjusted ICER of $64 (95% CI -$10, $809) per additional minute of outdoor free play opportunity per day, per service. Findings suggest GOGA may be considered cost-effective compared with a school-based physical activity implementation programme. Economic evaluations of similar ECEC-based programmes are recommended.